Psychological Medicine

Original Articles

Early detection of psychosis: positive effects on 5-year outcome

T. K. Larsena1a2 c1, I. Mellea3a4, B. Auestada5, U. Haahra6, I. Joaa1, J. O. Johannessena1, S. Opjordsmoena3a4, B. R. Runda7, J. I. Rossberga3a4, E. Simonsena6, P. Vagluma8, S. Friisa3a4 and T. McGlashana9

a1 Stavanger University Hospital, Psychiatric Clinic, Stavanger, Norway

a2 Department of Clinical Medicine, Section Psychiatry, University of Bergen, Norway

a3 Oslo University Hospital, Oslo, Norway

a4 Institute of Psychiatry, University of Oslo, Norway

a5 Faculty of Science and Technology, University of Stavanger, Norway

a6 Psychiatric Research Unit and University of Copenhagen, Zealand Region Psychiatry Roskilde, Denmark

a7 Vestre Viken Hospital Trust/Department of Psychology, University of Oslo, Norway

a8 Department of Behavioral Sciences in Medicine, University of Oslo, Norway

a9 Yale University School of Medicine, New Haven, Connecticut, USA

Abstract

Background During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.

Method During 1997–2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter.

Results At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.

Conclusions Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.

(Received June 15 2010)

(Revised September 16 2010)

(Accepted September 16 2010)

(Online publication October 14 2010)

Correspondence

c1 Address for correspondence: T. K. Larsen, M.D., Stavanger University Hospital, Division of Psychiatry, Armauer Hansensv 20, p.b. 8100, N-4068 Stavanger, Norway. (Email: tkmaclarsen@mac.com)

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